There was something else I found, as I combed through all of these books and articles and Youtube clips of conferences on resilience. What else was everyone saying about resilience and how to achieve it?

Another thing that came up was this idea that a sense of personal agency or autonomy was a necessity in achieving resilience. Personal agency is an important thing to keep in mind and to strive to achieve when feeling beat down because it gives an individual the power to exert influence on his environment.

Agency (from Mirriam Webster): the capacity, condition, or state of acting or of exerting power : operation

Just add the personal to it…personal agency…so we’re talking about personal power or empowerment.

Autonomy (from Mirriam Webster):1 : the quality or state of being self-governing; especially: the right of self-government2 : self-directing freedom and especially moral independence personal autonomy3 : a self-governing state

To become resilient and to rise above, it takes a certain measure of personal agency or empowerment because for the marginalized, power has in some sense been taken away. It also takes a certain measure of autonomy because as Reality Therapy and Choice Theory from William Glasser tells us freedom is a basic need in life. Freedom gives us the power to choose and the ability to be independent or autonomous.

The other 5 basic needs Choice Theory lays out are power, love and belonging, freedom, fun, and survival. Power--there's the personal agency again. It is not these basic needs that are driving us towards action, more our wants. And wants are very strong motivators for action, but they do not automatically give us the ability to control outcomes.

We can control what we can control. In other words, we can control what is within our circle of influence—utilizing both personal agency and autonomy along with the freedom to choose. While we have a responsibility toothers, the saying goes, we do not have responsibility for others.

At least not in most contexts, I’m not talking about the caring for the ill or the raising of children or taking on the responsibility of others who have difficulty meeting their own basic survival needs. I’m talking about feeling responsible let’s say for someone else’s poor choices or for someone else’s feelings. The choices that other people make are not our fault.

It also flows the other way, we cannot blame others for the decisions we make claiming a kind of “well if they hadn’t done that, then I wouldn’t have. . . .” Eric Greitens, the ex-Navy seal in his book Resilience: Hard-won wisdom for living a better life talks about the importance of accepting personal responsibility as part of becoming resilient which involves first the awareness that we have the ability to choose.

He equates the process of making courageous choices with the process of making resilient choices. And come to think of it resilient choices take courage. What might be a resilient choice? A resilient choice could be the choice that while an individual was born of a parent who may be abused substances or was in and out of prison, not to become a statistic and follow in their footsteps.

A resilient or courageous choice might be to leave an abusive spouse. A resilient choice might be to step into one’s authentic identity when doing so pits one against stigma and discrimination and risk of job loss. It takes courage to break the mold, to forge new territory, to go against the grain.

There is a quote that I came across once that a friend had relayed to me. The quote is by Eleanor Roosevelt. Eleanor says “Do what you feel in your heart to be right- for you'll be criticized anyway. You'll be damned if you do, and damned if you don't.”

Part of going against the grain is shedding the weight and burden of conventional expectation which for some shames an individual into fitting in. Caught up with conventional expectation is the tie to perfectionism. Within perfectionism is the felt presence of “the other” the person(s) who are there to judge.

Regardless of judgment and in spite of judgment there is a place one can go to that is deep inside, a place of inner peace from which decisions can be made. So the building blocks then as laid out here would be 1) awareness of personal agency, then 2) the ability to act independently or autonomously, 3) to make courageous choices, that 4) may go against the grain, and that 5) shed the idea of perfectionism because resliency is more about belonging to oneself or finding one’s own identity than it is about fitting in with others.

This first semester of classes is over. I’ve narrowed down even further what I want my capstone project to focus on. I started out writing about wanting to address the issue of achieving equal opportunity and justice. I wrote about how this particular grand challenge underlies all of the other grand challenges. My new focus is on health disparities related to mental health and closing the health gap.

This semester we went through the basics of innovation dynamics: actors, limits, history, future, configuration, and parthood. We traced social norms and thought about ways of both deviating from them and then diffusing the deviation. I traced the social norm of 1) The idea that people are "crazy" and 2) That the mentally ill cannot function or participate in regular society fully because they are mentally ill.

The state of mental health care in the United States has declined steadily. According to the Center for Mental Health Services (CMHS) as part of the process of deinstitutionalization the number of patients in state and county psychiatric hospitals has decreased from 512,501 beds in 1950 to 49,947 beds in 2005 (Eckart, 2010). That is a 90% decrease, so that today there are about 14 beds per 100,000 people.

That same ratio was approximately the ratio of beds to persons treated in 1850 (Torrey, Fuller, Geller, Jacobs, & Ragosta, 2012). With all of these individuals released from state and county psychiatric hospitals the question becomes where are these individuals now being treated?

Today there are 3.9 million people with severe mental illness who are not receiving any form of treatment (Mondics, 2014).. The dismantling of the scaffolding by which the mentally ill were formerly treated did nothing to eradicate the issue of mental illness itself. Individuals have continued to go on needing treatment.

Instead one third of the homeless population suffers from mental illness (Mondics, 2014). Jails and prisons in the United States are holding three times the amount of seriously mentally ill individuals than hospitals (Torrey et al., 2012). In other words, because individuals are going untreated they often end up either living on the streets or in prison.

The Adverse Childhood Experience (ACEs) study that took place in the 1990s was a study conducted by a major health insurance provider Kaiser Permanente in California. It sought to connect the linkages between adverse experiences and later health crises (Lanius, Vermetten, & Pain, 2010). This study points to the relationship between body and mind—between mental and physical health.

The relationship, however, is not straightforwardly biomedical but caused by coping mechanisms induced by the psychological distress that mental health issues bring (Lanius et al., 2010). We know that living with depression and chronic health conditions decrease one’s quality of life. Psychological distress and physical illness, in turn, contribute to shortened life expectancy rates.

Globally, the average life expectancy has doubled since 1900 with the average life expectancy today nearing 70 years. In the year 2000 the world’s population was around 6.1 billion and by 2050 it is projected to be 9.4 billion (United Nations, 2003). There is no country in the world so dispossessed that it has a life expectancy at its highest that reaches what the highest life expectancy was in 1800 (Roser, 2013).

Yet, while life expectancy rates have improved overall, people with severe mental illness have a 13 to 30 year shortened life expectancy rate than the average person (De Hert et al., 2010). There are societal shifts and changes taking place within the health care field in other ways.

The top 10 big pharmaceutical companies known as “Big Pharma” make more money every year than the other 490 companies on the Fortune 500 list combined (Malagutti, 2007). This excessive profit is indicative that the business of medication is big business. In 2015 there were 67, 753 pharmacies nationwide.

The United States has a reputation of aggressive forms of medical treatment not the least of which is the over prescription of pharmaceutical drugs. And yet, due the to the extreme proliferation of pharmacies, if pharmacies like Walgreens alone were to open a health clinic in each of its stores about three fourths of the population of the United States would have access to health care (Singhal, 2017). In other words, the United States has the delivery and distribution methods to think of creative ways of providing better treatment at the ground level.

There are different theoretical frameworks that tie into the crisis we see in health care. One of those frameworks was developed here at The University of Texas at Austin by Steele and Aronson. Steele and Aronson (1995) define stereotype threat as “being at risk of confirming, as self-characteristic, a negative stereotype about one’s group.”

The fear is that an individual will be judged by his actions or treated in a stereotypical fashion whether the individual believes in the stereotype or not. The authors pointed out that African-American students at the time may also have been loaded with what the researchers called “self-threat” or a hyperawareness or self-consciousness about their abilities which interfered with performance.

A similar thing may be at play for individuals experiencing mental illness and in both a stigmatized and power down position. Whether an individual believes in the stereotype placed or not is an important point. Cognitive dissonance theory which was developed by Leon Festinger (1962) describes the situation in which an individual might hold attitudes and beliefs that are different from her behaviors.

So conceivably a person might be born into unfortunate circumstances and find themselves marginalized and with the mark of stigma and feel the effects of prejudice and discrimination in society yet believe themselves to be worthy despite social norms. But their behaviors nonetheless may put them into situations in which they would reinforce social norms and perpetuate the stigma and discrimination that follows even though their attitudes and beliefs differ.

As an example, an individual with mental illness may have some sense that she is capable of holding down work, yet because her caseworker reinforces the social norm that claiming disability may be the more appropriate option the individual with mental illness may go ahead and file. The disharmony creates cognitive dissonance or turmoil within the individual.

For the individual in this example it is a message both of “I’m capable and I’m incapable.” The mentally ill who find themselves in cognitive dissonance are forced into a situation then where something has to change in order to create harmony. They therefore either change their attitudes and beliefs to be in greater alignment with their behaviors and buy into the idea that they are in fact incapable.

Or they reduce the importance of their conflicting attitudes and beliefs, by perhaps believing on the one hand they are capable yet perhaps incapacitated by outside forces. Conversely, a person with mental illness might, in fact, believe in accordance with social norms that he is damaged, flawed, and crazy.

Yet he may engage in prosocial behaviors that would suggest the believes that he is capable of some level of functioning in society by for instance holding down a job, but still the inner disharmony and conflict. His inner belief in being flawed may later come into play when problems arise at work.

In order to bring his attitudes and beliefs in alignment with his behaviors again something needs to change. Instead of fighting to keep his job and work on whatever performance issues are at play he might instead take a defeatist attitude and give up on work to support his innermost belief that he is flawed and incapable.

It is possible that he may find treatment for his negative core belief that he is incapable and bring the new belief that he has the capability into alignment with more prosocial behaviors of seeking to find enjoyable work. Attitudes and beliefs must somehow come into alignment or they create psychic tension. Aronson’s stereotype threat and Festinger’s cognitive dissonance theory work in conjunction in terms of affecting health outcomes.

Those stigmatized with mental illness as in the example above may according to Aronson: 1. avoid treatment, 2. experience impaired communication during treatment, and 3. face poorer adherence to treatment plans by virtue of a type of learned helplessness. All of these behaviors may certainly be influenced by the inner disharmony felt. (Aronson, Burgess, Phelan, & Juarez, 2013).

The topic of empowerment is key when dealing with marginalized populations such as those with disabilities. Empowerment serves as a means of bringing into greater alignment one’s attitudes and beliefs and subsequent behaviors. A book published in 2018 by Oxford University Press reveals a mapping out of the role of stigma and discrimination.

It starts with an explanation of discrimination at all levels (cultural, institutional, and interpersonal) and then traces the role of discrimination in social cognitive processes, health behaviors, emotional and physiological reactivity, emotional and psychological recovery, and sustained psychophysiological dysregulation (Major, B., Dovidio, J. F., & Link, B. G. (2018).

The authors map the connections between stigma and discrimination and how they lead to choices in life at the individual level that in turn can contribute to adverse health outcomes. One example of this is stigma and discrimination leading to the unpredictable availability of needed resources which influences opportunistic risk-taking behaviors which may then lead to physical injury or drug use.

If the approach to the problem were to on one hand make health care easily accessible and easily affordable and empowering while on the other hand work to reduce stigma and discrimination, we may see progress on this issue. A model of empowerment for those marginalized with mental illness which seeks to into introduce the idea that people with mental health issues are normal and works against stigma and discrimination, stereotype threat, and cognitive dissonance may encourage those experiencing mental illness to bring their attitudes and beliefs into alignment with behaviors.

This could be done by providing greater education, tools, and resources to those suffering. This might assist with the reduction in both morbidity and mortality—improving both quality of life and life expectancy rates. This semester I began to flesh out a prototype for addressing the crisis in mental health care perhaps by the delivery of tools and services through a platform built on blockchain technology.

Mondics, J. (2014, July 25). How Many People with Serious Mental Illness Are Homeless? – Treatment Advocacy Center. Retrieved from http://www.treatmentadvocacycenter.org/fixing-the-system/features-and-news/2596-how-many-people-with-serious-mental-illness-are-homeless

United Nations. World population projected to reach 9.6 billion by 2050. Department of Economic and Social Affairs. (2003, June). Retrieved from http://www.un.org/en/development/desa/news/population/un-report-world-population- projected-to-reach-9-6-billion-by-2050.html

What Is a DSW Exactly? What Else Are We Learning?—And My Faculty Advisor

by Monica A. Ross, LPC

I’ve been assigned an advisor for my thesis. Her name is Dr. Amanda Stylianou. She’s an LCSW practicing out of New York and the Associate Vice President for Quality and Program Development at an organization called Safe Horizon.

Safe Horizon is the largest nonprofit victim services agency in the United States. They work with victims of domestic violence, child abuse, sexual assault, and human trafficking. I’m very much looking forward to working with Dr. Stylianou.

Just about one month has gone by in this program. The pace of working full-time and attending 4 hours of virtual class time a week in addition to the outside readings that we have to do has been challenging.

I feel like we’ve covered so much territory already. That would make sense because we’re doing things at a very fast pace. This program is only 24 months long. To those who would say, how can a doctoral program be only 24 months long?

I’d say this: The licensure that I have for my LPC took approximately 6 years to complete from start to finish. So in some sense, I feel as though my dues in terms of gaining an education at the graduate level and in time spent training for my profession have been paid.

These 2 years in the doctoral program will make it about 8 years of education and training post BA total. Most traditional PhD programs require about the same amount of time to complete coming straight from undergraduate school. So, in a way, I look it like I took the complicated route to a doctoral degree, which seems to be more in line with my style.

Previous to even starting my master’s, I had accumulated over 20 years of work experience in a range of industries which gives me a wide perspective on office structures and organizational policies. Because the focus of this doctoral program is on social innovation and where systems in society overlap with social problems, that experience will help with the work that I’m doing as well.

Academic programs that are online or remote come under scrutiny for not being as rigorous as brick and mortar academic programs. And there are some online academic programs out there that may not be.

However, I can say that in this doctoral program, I’m meeting with a small group of up to 15 other students twice each week for a couple of hours each class. This doesn’t include time spent in group meetings that we have outside of class for group projects. We also have readings and assignments to complete consistent with more traditional academic programs.

The virtual environment as an educational tool is not going away and I’m excited to be participating in it with an academic institution that is on the leading edge of that front. Some might ask, what is a DSW anyway? It’s a doctorate, but it’s not the same as a PhD.

The DSW is to social work as the PsyD is to psychology. A DSW degree is a bit like a PsyD in that it emphasizes professional practice over research. That’s not to say that I can’t conduct research or teach for that matter, but solely conducting research and teaching isn’t my current aim.

What else are we doing in this DSW program? We’re examining different organizational change models, we’re combing through databases from peer-reviewed journals, we’re creating annotated bibliographies for our separate projects, we’re applying the models we’re learning in class to case study examples on various social problems.

And we’re doing all this from the standpoint that at some point the models we are learning will be applied to the separate projects that we are working on for our capstone thesis. We’re also hearing from thought leaders in a kind of a guest lecturer format who have taken the time to sit for recorded interviews specifically for our class on the topics we are covering—Freddy Mutanguha of the Holocaust Memorial Trust gave a lecture for our class recently, and Karen Freidt who is the Creativity and Innovation Program Manager for NASA’s Langley Research Center gave a lecture.

As I watch these leaders of industries with experience in anything from science and engineering to outreach and education programs in East Africa, I feel truly inspired by the lessons they are imparting from the work they are doing in their various fields. A couple of things stand out for me as lessons learned by these leaders of industry.

Number one is the importance of not trying to solve a problem for someone else that you don’t yourself understand. I’m playing with the idea of using health disparities as my focus because it’s something that I intimately understand. When I use the term health disparities, I’m talking about group differences in physical health that are influenced by inequalities in society that are socially determined by such things as access to proper nutrition, education, employment, housing, and transportation.

Both of my parents were chronically ill and social determinants in some sense affected both their access to care and the quality of care they received. But I don’t have to go there. I can stop with the fact that I myself am a member of more than one social grouping that often faces stigma and discrimination in society. I could look to my friends who themselves are in groups that are stigmatized and discriminated against. So, yes, a problem that I intimately understand, check mark.

Number two is that while it’s important to be passionate about your work, it’s also important to set the intensity of that passion so it’s not so high that your field of vision is narrowed. As far as dialing down the intensity goes, that’s hard to do. Because these issues for me are personal, as I mentioned, not just because my family members have been affected by these things, but my friends, myself.

My colleagues and I are doing this work doubtless because it feeds into our sense of purpose in life, but at the same time, a certain measure of detachment is needed in order to continue to learn and think critically and challenge long-held beliefs and presumptions, some of which might be our own. David Perkins from the Graduate School of Education at Harvard is attributed as having said that 90% of errors in thinking are not errors of logic but errors of perception.

I’ll take it a step further. It’s our perception arguably from which we derive our logic. In other words, our perception or beliefs influence not only the way that we view ourselves but the way in which we view other people, and the way in which we view the very world we live in.

I went through some old boxes recently and dug up a paper I had written as an undergraduate—it was my thesis for the Honors program in Sociology at The University of Texas. My topic for the paper was the sociology of emotions and a look specifically at the emotions of guilt and shame. In the paper I start first by talking about guilt.

Our feelings of guilt have a strong linkage to our feelings of fear. Early on we as children come to learn our sense of guilt from the fear of punishment by our parents. According to the sociologist Theodore Kemper, writing in the late 1980s, as we grow into adulthood that same fear becomes internalized such that no one need know how we have transgressed. It’s the mere act of doing something for which we feel there ought to be punishment that can spark our guilt.

Kemper also cites a previous study conducted by Virginia Demos indicating that mothers use mainly positive verbal interactions with their children aged 9 to 15 months. Another researcher, Martin Hoffman, found that mothers use more corrective pressures for their children ages 2 to 4 years—guiding their children to change their behavior on average every 6 to 8 minutes during the child’s waking hours.

Now these studies were conducted in the later part of the 20th century and with children who were born into the X generation. But still, it’s common sense and still widely observed today that as children get into the toddler stage they tend to do more exploring and test boundaries and as such likely incur greater guidance by their caregivers.

But what the article by Kemper also notes is that part of the effectiveness of something like the socialization of guilt might be the concomitant withdrawal of love by a caregiver, which may be what the young child perceives their punishment as. And the withdrawal of love can be a very powerful motivator.

But what does guilt do for us really as human beings? Without guilt we may not have reform, some argue. In other words, it is something we go through in repentance arguably to the one or ones wronged. In this way, guilt might be thought of as necessary for reinforcing the social order and for changing one’s behavior.

However, according to Kaufmann in Without Guilt and Justice, guilt doesn’t serve anybody justice really. The person feeling guilty may blame the victim as the source of their guilt and the victim may feel guilty because the perpetrator resents him. Instead of guilt Kaufmann advocates for humility and ambition, which recognizes that we are all fallible and that we aspire to do better.

This goes well with the idea that at any given point in time we are only acting from the level of conscious awareness we have in any given moment. I wrote earlier on the topic of forgiveness and the notion that letting go of guilt is letting go of the hope that the past could have played out any differently.

So how does shame differ from guilt? Shame is linked to our concept of self in relationship to and comparison with others. With shame we are consciously aware of ourselves as a separate entity from others, and from such a place note both our similarities and differences with a focus on differences.

Whereas with guilt we might in some sense extract the guilty act from our sense of self, with shame the act we commit for which there might be some sense of shame attached is more intimately tied to our sense of self or our identity. Researchers like Susan Shott from The University of Chicago wrote about this.

While guilt might have the associated emotion of fear tied to it, with shame we often experience anger and/or embarrassment. The anger that comes with shame may not be outwardly expressed but inwardly expressed—it is anger towards ourselves at times for our own perceived deficiency. And we know that anger directed inwardly can lead to things like depression.

But shame might also give rise to an unfocused and outward expression of anger and hostility towards a real or imagined other, which in a way mobilizes our wounded selves for action and gives us a false sense of empowerment. June Tangney at George Mason University has written about this.

Shame could be about a loss of pride or a perceived loss of status. Carl Schneider in Shame, Exposure, and Privacy asserts that we in modern society “…believe in an isolated identity (‘I am as the Other sees me’) and deny our communal nature (‘I am as the Other is’). The recovery of a proper sense of shame would go hand in hand with our acknowledgment of radical sociality.”

His words tie in nicely with Kristin Neff’s more recent work on self-compassion and the notion of our shared common humanity. Thomas Scheff and Suzanne Retzinger, both from UC Santa Barbara, propose that our Americanized myth of individualism is in direct response to the pain of threatened bonds. When our bond with another is threatened, we might lean more on individualism so as not to feel the pain that is sometimes involved in relationships that are in disrepair.

And/or we go the other way with it and in some sense tolerate relationships that do not meet our needs rather than face the loneliness of isolation. John Bowlby would add that the nearer that people get to a state of bondlessness or alienation from others the more likely they are to become violent or mentally ill or both.

So how to begin to tie all of this together? Well, the original idea for exploring these negative emotions on my part is because these emotions come up for people with stigmatized identities whether these identities are concealable or not. Stigmatized identities fall under the category of identities associated with things like mental illness, sexual identity, racial identity, physical disability, social deviancy, economic disadvantage, and physical appearance.

Stigmatization of behaviors occurs in society as a means of establishing social norms. A social norm is simply the behavior that a society deems acceptable. Why even have social norms? We have social norms so that we don’t fall into chaos as a society and so that we can set expectations for the ways in which we interact.

We have social norms so as to provide some sense of social order. However, while social norms perpetuate prosocial behaviors which can be a good thing, some argue that they can also lead to negative consequences and maladaptive behaviors like obsessions over beauty or weight or the tendency to lean towards perfectionism.

Social norms might also be viewed as a means of social control. A well-known American sociologist Talcott Parsons wrote about this in the late 20th century.

I’ve run into people lately who know my intent of writing a book and they’ve been asking me, “Well what's it about?” I say that I have a loose sketch. There are several themes that I want to tie in together. The general themes are poverty, stigma, mental health, physical health, behavioral economics, and therapeutic techniques like cognitive behavioral therapy.

I’ve thought about going back to school to advance my studies even further. And recently, I applied to a couple of doctoral programs. Both of these programs are online and shorter in length than a traditional PhD track program, which would be geared more towards someone who wants to end up conducting research and teaching in academia. The one doctoral program that I am looking at in particular would place the emphasis on clinical practice.

I don’t know whether or not I’ll get into my program of choice or whether or not having gained the acceptance I’ll sign the piece of paper that commits myself to even more student loan debt. But I thought I’d use this post to explain some of my background or reasoning for wanting to pursue the idea of writing a book.

I made some of the following statements in my personal statement submitted to the doctoral program that elucidate my intent a little bit more:

Extreme economic inequality is a public health problem. As a health care provider, I want to advance well-being practices geared towards overcoming the unique psychological barriers that economic inequality perpetuates in order to stimulate behavioral and economic change. The government focuses on prevention and early intervention for “at risk” youth, and this leaves out our adult population, an even larger demographic.

Some of the adults I have treated were not able to get early interventions and therefore find themselves struggling later in life. I am intrigued by the work of Eldar Shafir and Johannes Haushofer, both from Princeton University, who are leading the conversation linking poverty to psychology and tracing this linkage to its economic impact.

In my early years, in Texas, I saw the struggles my parents had with chronic health impairments and economic inequality. This influenced my decision to go into psychology and sociology as an undergraduate student and to focus my studies on resilience and well-being later in life.

I did not see the burden of my parents’ health and financial issues, or my own issues for that matter, as resting solely on our shoulders. Instead, I had some sense there were environmental and societal factors affecting our overall health and well-being. I am an advocate of personal agency and responsibility, while at the same time acknowledging that we, all of us, live in systems.

After graduation I spent many years working in California at corporate, government, nonprofit, and academic institutions. I chose this path of work because I chased after the financial security that these roles provided. In 2010 I made the decision to come back to Texas to be with family and I came up with a plan to pursue my calling—to return to the study of psychology and to become a psychotherapist.

By August of 2011, I was enrolled full-time in a counseling program at St. Edward’s University. By May of 2014, I finished my counseling program and graduated with a 4.0 GPA. With my master’s degree and LPC-intern license in hand, I made the decision to relocate to rural East Texas because of the experience it offered.

I began working at Burke, a Federally Qualified Health Center headquartered in Lufkin. It serves a 12-county region and houses services for people across the life span, from children to adults, with mental health and medical issues. At Burke, I worked initially with the most severely mentally ill in vivo as a caseworker.

In that role as an in vivo caseworker, I came face-to-face with the devastating effects of poverty in America and its relationship to mental health. After a year as a caseworker, I transitioned to the office and provided psychotherapy at the clinic for our clients that included 50- to 90-minute individual counseling, group therapy, and psychoeducational sessions.

I discovered a wellness self-management personal workbook from the New York State Office of Mental Health and used that as a tool to lead a 12-week series of group therapy sessions. I also drove once a week an hour outside of Lufkin to Crockett, a town of less than 7,000, in order to provide therapy to the neediest in that community. Crockett has a 39.1% poverty rate.

In some ways, I had escaped the financial and cultural struggles of my early years for an interlude while in working California only to willingly come back to my home state and face those same struggles again, but from a different perspective. Once I finished the licensure process, I moved back to Austin to embark upon my own private practice.

Throughout my experience as a counselor, I have continued to work with clients of all ages in all levels of socioeconomic status. I have clients who have been in and out of prison, who have had Child Protective Services (CPS) involvement in their lives, and who are struggling to maintain independent housing, access to proper nutrition, and transportation.

I have also worked with top executives of well-known companies who are somewhat more economically privileged, but often face similar mental health challenges and have had to overcome sometimes similar childhood trauma.

By addressing the unique psychological barriers that people coming from a place of extreme economic inequality face, we can more adequately advance long and productive lives. This may come through a process of creating social responses that include therapeutic techniques to adapt to the changing social environment.

The experiences that I have had throughout life, the witnessing of the effects of extreme inequality, which are influenced by both societal factors and internalized psychological barriers, have taken on new meaning for me. These experiences were not random occurrences, but instead have prepared me for the work that I currently do and for the legacy that I hope to one day leave.

I’m going to navigate to a topic that is really such a sensitive one for so many reasons. And I’m going to try to treat it as delicately as I can. While I’ve written in the past about the medical model approach to psychology and have given it some criticism I wouldn’t want for my readership to assume then that I am anti-medication.

It is not my job to decide for others what to and not to take prescription-wise. I am not a psychiatrist. I was once called to court to testify and on cross examination was asked, "In your opinion should your client be on medication for the rest of their lives?"

First of all, as I said, I'm not a psychiatrist. Second, how can I possibly answer a question like that even if I were a psychiatrist? When working with clients, I point out a range of possibilities in terms of symptom management but ultimately it is up to them to discover what they believe to be the right choice of treatment for their own health.

For some that means taking Zoloft and Xanax and for others it means taking whatever natural remedies are available to them like St. John's Wort and Rescue Remedy. For some, it means taking both. It’s a very personal decision, as personal as choosing whether or not to take birth control or undergo chemotherapy and radiation treatments in the case of cancer.

I have known people who have started out on mental health medication and have been on it their whole lives. I have also known people who have never been on mental health medication who only start to take it in their 70s or 80s. And then there are those who have never been on mental health medication and never will.

Some people in this profession take a hard and fast stance on the topic. At this time, I do not. There are those in behavioral health who rail against the prescription and over prescription of drugs. A well known example is William Glassner, the founder of Reality Therapy, a psychiatrist himself he wrote a book called Warning: Psychiatry Can Be Hazardous to Your Mental Health.

There is also a non profit organization called The Icarus Project that has published a free resource for those choosing to ween off of psychiatric medication recognizing that there is no single solution for every person. The Icarus Project emphasizes the harm reduction model and offers support in people’s decision making process.

Just to balance this post out there are also those who emphasize the importance of taking medication exactly as prescribed. The U.S. Food and Drug Administration lists this on their website a section called “The High Cost of Not Taking Medication as Prescribed.” There are those clients who have been successful in weening off of medication and there are those clients who tell me that every time they have tried to ween off of medication they have faced adverse affects.

I have heard some psychiatrists tell their patients, "If a person has diabetes would you tell them not to take insulin?" They say that medication for mental health is one and the same—it is about taking medication to treat a nascent illness. In other words, mental illness is caused by biology, by chemical imbalances and the like--just like any physical illness.

There is another theory out there called the neurogenesis theory and when I was working at an MHMR clinic in deep east Texas I often told my clients about this theory, as well. According to the neurogenesis theory, taking mental health medication in some instances can actually lead to the regrowth and regeneration of cells in the hippocampus where, like in cases of major depression, their is a deterioration of cells.

This video called "The Science of Depression" talks a bit about that theory. But later in 2016 this article came out criticizing this theory somewhat stating that if neurogenesis in fact does take place, it takes place at such low rates in humans as to render it statistically insignificant. Argh.

Some argue that mental illness is more complex than reducing it to simply biology. These resources here are offered to assist in the decision making process but as you will see there are people on polar opposites of the camp. With many health care professionals you will find an attempt at a balanced approach that acknowledges both sides of the argument.

Psychiatrists might start their patients on low doses and suggest psychotherapy as an adjunct to treatment. What sometimes happens is that the lower dosages slowly increase and patients find themselves on not only higher and higher dosages, but a multiplicity of medications. This is just something that I have observed.

Again, it’s about personal choice. In a place like Austin with a culture that promotes alternative therapies and treatments and leans more on hippie tendencies and all that comes with that--like shirking the pharmaceutical establishment, there is at times more pressure for those who choose to take mental health meds. Some therefore feel that it is something to be hidden, a form of weakness, or of giving in to the establishment.

This aggravates me a bit. It makes me think of moments when I've had to hide my Starbucks purchase or admit to forgetting to bring my own cloth bag to the grocery store in an effort to save the environment only this time we're talking about healthcare and what people decide to do with their bodies.

Again, it comes down to personal choice. But choice needs to be an informed one that ultimately is led by self-determination. I will say that the people making these decisions about their health and whether or not to take medication or not deserve all the respect and support that they can get because it is not an easy decision to make for some.

There are pros and cons to taking psychiatric drugs with some experiencing symptom relief while others complain of the negative effects like reduced sex drive, or foggy brained-ness, or numbness of feelings. Some claim that medication has saved their life and that they are able now to get up and function where there was no functioning before.

With statements like these I find it hard to be insensitive on the matter, especially when people are talking about symptoms that for some that are very debilitating. So first and foremost I think it's about respect for people's ability to make decisions about their own healthcare.